RT Journal Article
SR Electronic
T1 Retrospective review of Synacthen testing in infants
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP archdischild-2017-313819
DO 10.1136/archdischild-2017-313819
A1 Timothy Shao Ern Tan
A1 Claire Manfredonia
A1 Rakesh Kumar
A1 Julie Jones
A1 Elaine O’Shea
A1 Raja Padidela
A1 Mars Skae
A1 Sarah Ehtisham
A1 Fiona Ivison
A1 Lesley Tetlow
A1 Peter E Clayton
A1 Indraneel Banerjee
A1 Leena Patel
YR 2018
UL http://adc.bmj.com/content/early/2018/01/11/archdischild-2017-313819.abstract
AB Background A subnormal cortisol response (30 min level (C30min)<550 nmol/L) to synthetic adrenocorticotrophic hormone/Synacthen test (SDST) in all infants does not necessarily indicate underlying or persistent hypothalamic–pituitary–adrenal axis pathology.Methods We retrospectively evaluated the diagnoses and outcomes in 68 infants who had a SDST at age <6 months from 2011 to 2014.Results 29 (43%) infants had a subnormal SDST. Causative pathology was identified in 9/29 (31%). In 20/29 (69%) with no identified pathology, repeat SDST was normal in 18/20 (90%) at median age 0.6 (range 0.1–3.2) years but persistently subnormal in 2. Those with a transient abnormality were more likely to be small for gestational age (P=0.03) and had higher initial SDST C30min (390 nmol/L vs 181 nmol/L, P=0.01) than those with pathology.Conclusion Specific aetiology can be identified in a third of infants with a subnormal SDST. When the aetiology remains elusive, adrenal function should be reassessed as the problem can be transient.